MEDICARE: PHUNG KIM DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	36576	TX

General Provider Information

NPI Number	:	1609477876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHUNG KIM DO

Provider Business Mailing Address
First Line	:	4122 LBJ FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5703
Country	:	US
Telephone Number	:	972-239-4297
Fax Number	:	972-458-1162

Provider Business Practice Location Address
First Line	:	4122 LBJ FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5703
Country	:	US
Telephone Number	:	972-239-4297
Fax Number	:	972-458-1162

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2020
Last Update Date	:	11/04/2020

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Directions to “ PHUNG KIM DO ” Practice Location

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